Intensified External-Beam Radiation Therapy Improves the Outcome of Stage 4 Neuroblastoma in Children &gt; 1 Year with Residual Local Disease

Simon, Thorsten; Hero, Barbara; Bongartz, Rudolf; Schmidt, Matthias; Müller, Roman‐Ulrich; Berthold, Frank

doi:10.1007/s00066-006-1498-8

Cited by 76 publications

(46 citation statements)

References 29 publications

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“…Recently IORT has been described in a cohort of pediatric patients with varying benign conditions and malignancy [5]. EBRT also has been described that it was effective in advanced neuroblastoma [19][20][21]. The importance of intensive local treatment for advanced neuroblastoma was emphasized in other studies [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 97%

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

et al. 2007

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The purpose of this study is to evaluate the efficacy of intraoperative radiation therapy (IORT) and the problem of securing the IORT field in advanced pediatric neuroblastoma. Between 1996 and 2005, 12 children received IORT for advanced pediatric neuroblastoma patients. Electron beam energies ranged from 10 to 12 MeV and median dose was 10 Gy (8-12 Gy). All of them had surgery with IORT against the primary tumor site and the abdominal aorta surroundings. A gross total resection (GTR) was achieved in 10 patients and subtotal resection (STR) was two patients. All of 12 patients were classified as high risk. Nine patients were alive 17-120 (mean 48 months) after diagnosis. Local tumor control was achieved in 100% of patients, of whom one experienced local recurrence outside the IORT field. At the operation, it was difficult to secure the IORT field because of the angle of the radiation cylinder in three patients. One of the three of these patients experienced local recurrence outside of the IORT field in the upper side of superior mesenteric artery and two of three patients had an external beam radiation after surgery, and there was no local recurrence. One patient had a postoperative ileus, and one patient had transient diarrhea and hydronephrosis. For advanced neuroblastoma patients, IORT produced excellent local control after surgery. However, there is a problem of securing the IORT field. For local control, it is necessary to add an external beam radiation after IORT when it is difficult to secure the IORT field.

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Section: Discussionmentioning

confidence: 97%

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

et al. 2007

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“…Locoregional control rates in different studies have ranged from 25% to 61% when no RT was used compared to 84% to 100% with systematic use of primary site RT (21-21.6 Gy to the primary site). Some studies have also suggested that a higher dose of RT may be needed for patients who do not achieve a GTR (8)(9)(10). A previous German study reported a 3-year event-free survival of 85% in patients with subtotal resection who received a median dose of 36 Gy (30.6-40 Gy).…”

Section: Discussionmentioning

confidence: 99%

Radiation Therapy to the Primary and Postinduction Chemotherapy MIBG-Avid Sites in High-Risk Neuroblastoma

Mazloom

Louis

Nuchtern

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Although it is generally accepted that consolidation therapy for neuroblastoma includes irradiation of the primary site and any remaining metaiodobenzylguanidine (MIBG)-avid metastatic sites, limited information has been published regarding the efficacy of this approach.Methods and Materials-Thirty patients with high-risk neuroblastoma were treated at 1 radiation therapy (RT) department after receiving 5 cycles of induction chemotherapy and resection. All patients had at least a partial response after induction therapy, based upon international neuroblastoma response criteria. The primary sites were treated with 24 to 30 Gy whereas the MIBG-avid metastatic sites were treated with 24 Gy. RT was followed by high-dose chemotherapy with autologous stem cell rescue and 6 months of cis-retinoic acid.Results-The 5-year progression-free survival (PFS) and overall survival (OS) rates were 48% and 59%, respectively. The 5-year locoregional control at the primary site was 84%. There were no differences in locoregional control according to degree of primary surgical resection. The 5-year local control rate for metastatic sites was 74%. The 5-year PFS rates for patients with 0, 1, 2, and >3 postinduction MIBG sites were 66%, 57%, 20%, and 0% (P<.0001), respectively, whereas 5-year OS rates were 80%, 57%, 50%, and 0%, respectively (P<.0001).Conclusions-RT to the primary site and postinduction MIBG-positive metastatic sites was associated with 84% and 74% local control, respectively. The number of MIBG-avid sites present after induction chemotherapy and surgery was predictive of progression-free and overall survival.

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“…1,33,34 A further development is the use of high doses of MIBG either alone or in addition to TBI and local radiotherapy, which may increase the chance of eradicating small tumour deposits. 35 8. The use of MIBG in place of TBI has been proposed in pilot studies 36,37 and was used in trial settings.…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

28 years of high-dose therapy and SCT for neuroblastoma in Europe: lessons from more than 4000 procedures

Ladenstein

Pötschger

Hartman

et al. 2008

Bone Marrow Transplant

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Between 1978 and 2006, the European Group for Blood and Marrow Transplantation registered 4098 high-dose therapy (HDT) procedures followed by stem cell rescue (SCR) (3974 autologous/124 allogeneic) in patients with neuroblastoma. The 5-year rates for overall (OS) and event-free survival are 37 and 32%, respectively. The median age at diagnosis is 3.9 years (0.3-62 years) with 76 patients older than 18 years. Patients above 10 years carry a 2.5-fold higher risk. Younger patients cure significantly (o0.001) better with OS rates of 40 and 30% for age groups 2-4 years and 4-10 years, respectively. Their risks are about twofold higher than that of patients below 2 years with OS rates of 60%. The better the quality of remission status before HDT/SCT the better are the observed OS rates: 43% in CR1 (1199 patients) and 42% for CR2 (140 patients), and 36% for those in very good partial or partial remission (1413 patients) and 21% for those with sensitive relapse (134 patients). Patients reported with stable disease in first remission still had an OS rate of 30%. Multivariate analysis shows significantly better OS in the age group of less than 2 years (o0.0001), as well as a better quality of remission status before HDT/SCT (Po0.0001), with the use of peripheral stem cells (P ¼ 0.014), autologous SCT (P ¼ 0.031) and busulphan/melphalan HDT (Po0.001). Busulphan/melphalan HDT/SCT in first remission achieves an OS of 48%, while it is only 35% with other regimens (Po0.001), including melphalan alone, other melphalan-containing regimens, a variety of other drugs given as a single HDT as well as the addition of TBI or sequential HDT/SCT procedures. Further progress in the field may only be expected from large-scale international randomized trials.

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Intensified External-Beam Radiation Therapy Improves the Outcome of Stage 4 Neuroblastoma in Children > 1 Year with Residual Local Disease

Abstract: EBRT appeared effective in high-intensive treatment of stage 4 neuroblastoma. It seems to compensate the disadvantage of incomplete response to induction chemotherapy. These retrospective results need confirmation by a prospective randomized trial.

Cited by 76 publications

References 29 publications

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

Radiation Therapy to the Primary and Postinduction Chemotherapy MIBG-Avid Sites in High-Risk Neuroblastoma

28 years of high-dose therapy and SCT for neuroblastoma in Europe: lessons from more than 4000 procedures

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